How to Lodge a Complaint with AFCA: Step by Step

To lodge an AFCA complaint, first complete your insurer's Internal Dispute Resolution (IDR) process or wait 30 days if they haven't responded. Then go to afca.org.au, click 'Make a complaint', fill in your details, upload your denial letter and supporting documents, and submit. AFCA will assign a case manager and contact your insurer directly. The service is free.

Key takeaways

• Complete your insurer's IDR process first, or wait 30 days if they have not responded.
• Lodge at afca.org.au with your denial letter, IDR outcome, PDS, and supporting evidence.
• AFCA will try conciliation first. If that fails, it moves to a binding determination.
• You have two years from the insurer's final IDR response to lodge. Do not delay.

If your insurance claim has been denied, underpaid, or simply ignored, you have the right to take your dispute to the Australian Financial Complaints Authority (AFCA). AFCA is a free, independent dispute resolution service that handles complaints about financial firms, including insurers. This guide walks you through every step of the process, from gathering your documents to understanding what AFCA can do for you.

What You Need Before You Start

Before lodging your AFCA complaint, you need to have gone through your insurer's internal dispute resolution (IDR) process. Under ASIC Regulatory Guide 271, your insurer must acknowledge your complaint within one business day and provide a written response within 30 calendar days.

You can lodge with AFCA once either of these conditions is met:

• Your insurer has issued a final IDR response (sometimes called a "final decision letter") that you disagree with
• 30 calendar days have passed since you made your complaint and your insurer has not responded

If your insurer has exceeded the 30-day timeframe without providing a response, this is treated as a "deemed IDR response" and you are free to escalate to AFCA immediately. This safeguard exists under the General Insurance Code of Practice to ensure insurers cannot delay their way out of accountability.

Documents to Gather

Having your paperwork ready before you start will make the lodgement process much smoother. Collect the following:

• Your insurance policy number and a copy of your Product Disclosure Statement (PDS)
• The insurer's final response letter, or evidence showing when you lodged your complaint if they have not responded within 30 days
• All correspondence with the insurer, including emails, letters, and notes of phone calls with dates
• Supporting evidence for your claim, such as photographs, repair quotes, medical reports, or expert assessments
• A clear timeline of events showing what happened, when you lodged your claim, and how the insurer responded at each stage

The more organised your documents are, the easier it will be for your AFCA case manager to understand your situation and advocate for a fair outcome.

How to Lodge Your Complaint

Online (Recommended)

Visit afca.org.au and select "Make a complaint." The online form guides you through each step. You will need to provide your personal details, your insurer's name, your policy number, and a summary of the dispute. You can upload supporting documents directly through the portal, which is the fastest way to get everything in front of AFCA.

By Phone

Call AFCA on 1800 931 678 (free call). Their team can help you lodge your complaint over the phone and answer questions about the process. Phone lines are open Monday to Friday, 9 am to 5 pm AEST. Interpreter services are available if you need them.

In Writing

You can also send your complaint by email to info@afca.org.au or by post to Australian Financial Complaints Authority, GPO Box 3, Melbourne VIC 3001.

Tips for Writing Your Complaint Summary

When describing your dispute, be clear and specific. State the facts in chronological order. Explain what outcome you are seeking, whether that is having your claim paid in full, receiving additional compensation, or having a decision reconsidered. Focus on what happened, what the insurer did or failed to do, and why you believe their decision was wrong.

Where possible, reference specific policy clauses or relevant sections of the Insurance Contracts Act 1984 (Cth). For example, if your insurer relied on a policy exclusion, explain why you believe the exclusion does not apply to your circumstances. If the insurer failed to act with utmost good faith as required under section 13 of the Act, say so and explain how.

What Happens After You Lodge

Once AFCA receives your complaint, the process follows a structured path:

1. AFCA sends you an acknowledgement, usually within one to two business days, confirming they have received your complaint
2. They assess whether the complaint falls within their jurisdiction (AFCA handles complaints about general insurance, life insurance, superannuation, banking, and other financial services)
3. A case manager is assigned who becomes your main point of contact throughout the process
4. Your insurer is notified and given the opportunity to respond to your complaint

In many cases, insurers will review their decision at this stage and may resolve the matter before it goes any further. The fact that AFCA is now involved often motivates a more thorough review.

The Conciliation Process

If the complaint is not resolved in the early stages, AFCA moves to conciliation. During this stage, your case manager works with both you and the insurer to try to reach an agreement. This might involve requesting additional information or documents from either party, facilitating discussions between you and the insurer, or making a preliminary assessment.

A preliminary assessment sets out how AFCA views the merits of your complaint based on the evidence so far. It is not binding, but it gives both parties a clear indication of the likely outcome. If either party disagrees with the preliminary assessment, they can request the matter proceed to a formal determination.

What a Determination Looks Like

If conciliation does not resolve the dispute, an AFCA ombudsman or panel will issue a determination. This is a formal, written decision that considers the evidence from both sides, the terms of your insurance policy, relevant legislation including the Insurance Contracts Act 1984, the duty of utmost good faith under section 13, and applicable industry codes of practice.

The determination explains the reasoning behind the decision and sets out any remedies. If you accept the determination, it becomes binding on the insurer and they must comply. If you choose not to accept it, you are free to pursue other options, including court action. The insurer does not have the option of rejecting a determination that you have accepted.

Remedies AFCA Can Award

AFCA has broad powers to resolve disputes fairly. Depending on the circumstances of your case, AFCA can:

• Direct your insurer to pay your claim, either in full or in part
• Award compensation for financial loss you have suffered as a result of the insurer's conduct
• Award compensation for non-financial loss (such as stress, inconvenience, or unreasonable delays) up to $6,300 for complaints lodged from 1 January 2024
• Direct the insurer to take specific actions, such as reassessing your claim or correcting their records
• Require the insurer to pay interest on amounts owed

For general insurance disputes, AFCA can consider claims where the amount claimed does not exceed $1,263,000 (in effect from 1 January 2024). AFCA adjusts its monetary limits every three years, with the next adjustment due 1 January 2027, so check the AFCA website for the current figure.

Time Limits to Keep in Mind

You generally have two years from the date of the insurer's final IDR response to lodge a complaint with AFCA. However, it is always best to act promptly. The sooner you lodge, the fresher the evidence and the easier it is to build a strong case. If you are unsure whether your complaint is still within time, contact AFCA directly and they can advise you.

How The Fair Claims Co Can Help

Preparing an AFCA submission that clearly sets out the facts, references the right policy clauses, and addresses the legal issues can make a real difference to the outcome of your dispute. A well-structured submission helps your case manager understand your position quickly and ensures nothing important is overlooked.

The Fair Claims Co specialises in preparing insurance dispute documents, including AFCA complaint submissions, responses to insurer positions, and supporting evidence packages. If you need help putting your case together, we are here to assist.